11-year-olds on the pill

While public schools need to offer age-appropriate sex education to children by the time they reach middle school, distributing birth control pills to 11-year-olds is going too far.

School officials in Portland, Maine, set off a national debate when they decided recently to approve distribution of birth control pills and patches at the city's middle schools without first getting direct permission from parents. While students must first get written parental permission to use the student health centers, treatment is confidential and students decide for themselves whether to tell their parents about the services they receive.

Granted, these health centers operate differently from the typical school nursing station, where young students often must get permission before the nurse can give them an aspirin. The Portland school health centers operate much like public health clinics and, under state law, once parents have given their children permission to use the clinic, reproductive health, mental health and substance abuse issues are confidential between medical providers and patients, regardless of the patient's age.

However, post-pubescent girls can receive prescription contraceptives only after undergoing counseling and being examined by a physician or nurse practitioner who can prescribe oral contraceptives.

We can envision situations when patient-doctor confidentiality would be appropriate. For example, if a student has a drug problem, he might be afraid to approach his parents about it but would be willing to talk with a medical provider at a school clinic and get help. Without a promise of confidentiality, that child might not be willing to seek help at all.

And there is no question that some middle schoolers are sexually active. In Portland, 17 middle school students have become pregnant in the past four years, seven in the 2006-2007 school year.

Nonetheless, we are alarmed that 11-year-old girls might be given prescriptions for oral contraceptives without their parents knowing about it. That completely usurps parental responsibility in regard to both the physical and mental well being of children who still are minors.

Birth control pills, after all, contain hormones that could have lasting health implications, especially if patients smoke while using them. Parents need to be part of that decision when their children are as young as 11 and 12 years old.

We understand that in some cases, children may not have parents or guardians who are willing to exercise that responsibility. But, in Portland and cities that have similar programs, parents who do want to play a role in their children's health are given an untenable choice: Deny children access altogether to the school health center, or give them unfettered freedom to make their own health choices, albeit with the guidance of a doctor or nurse.

We also question why it should be the function of the public school system to dispense contraceptives. While many high school clinics nationwide dispense condoms, offering prescription contraceptives in middle schools is a different matter.

The overarching concern is that, when it comes to reproductive health treatment for middle-school students, parents need to be involved.


n Portland, Maine, middle school students can get birth control pills without direct parental consent.